1. Andriy Lepyavko, MD, PhD Department of Internal Medicine № 2

2. WHO Report on the Global Tobacco Epidemic

4. According GOLD COPD – this is disease which is characterized by combination of clinical signs of chronic obstructive bronchitis (inflammation and narrowing of bronchi) and emphysema (changes of lung tissue structure).

5.  Permanent hyperactivity of parasympathetic nervous system with hyperproduction of acetylcholine, bronchial spasm and hypersecretion of mucus  Insufficiency of adrenal receptors in bronchial walls as the result of deep morphological changes with bronchial hypersecretion, bronchial spasm and cough  Bronchial hyperreactivity which is characterized by immune inflammation of bronchioles walls All that lead to:  1) narrowing of bronchioles;  2) development of emphysema

13.  Severe smoking  Occupational diseases  Family anamnesis  Chronic cough is the earliest sign of COPD and arise earlier then dyspnea  Sputum – as a rool in small amount, after cough  Dyspnea – persistent, progressive, becomes worse during physical activity and in severe cases – even if patient is calm

14.  Central cyanosis, emphysematous chest, additional breathing muscles are necessary for breathing  Increasing of breathing rate, decreasing of its deepness, prolongation of expiration  Percussion: decreasing of heart dullness  Auscultation: wheezing, dry rales, heart tones are dull

15.  Investigation of external breathing (spyrometry);  Bronchodilatation test;  Cytology of sputum;  Blood analysis;  X-ray;  ECG;  Blood gases Investigation of external breathing  FVC – max air volume which is expired during forced expiration after max inspiration;  FEV1 (<80 %)  FEV1/FVC (<70 %)  Peak flow (of expiration)

20.  Is necessary to find bronchial reversibility  Spyrometry has to be provided before and 15 min after inhalation of 400 mkg of Salbutamol (or 30-45 min – 80 mkg of Ipratropium)  Increasing of FEV1 more than 15 % tells us about reversibility

23. Stage and severity Signs І, mild FEV І ≥80%, FEV І /FVC < 70% - As a rule chronic cough with sputum II, moderate 50%< FEV І < 80% - FEV І /FVC < 70% - Symptoms are more significant, presence of dyspnea during physical activity and exacerbation III, severe 30%< FEV І < 50% FEV І /FVC < 70% - Symptoms cause worsening of life quality IV, very severeFEV І < 30% FEV І /FVC < 70% and CRF

24.  Increasing of intensivity of treatment in correlation with COPD severity;  Permanent basis therapy;  Individual sensitivity of patients to different medicines leads to necessarity of permanent control;  Inhaled medicines are useful.

28.  Short action – (Ipratropium bromid, Berodual Н) has more slowly beginning but longer action than β2-agonists  Prolonged action – (Thyotropium bromid, Spiriva ) is active for 24 hours   2-agonists of short action (Salbutamol, Fenoterol) – fast beginning of action, but duration – 4-6 hours   2-agonists of prolonged action (Salmeterol, Formoterol ) are active for 12 hours. Methylxantines  Theophyllines of prolonged action are useful – Teopec, Teotard.

29.  Are useful for permanent basis therapy for patients with COPD III-IV st.  Inhaled GCS are used.  Prednisone may be used only during exacerbation and is not recommended for basis therapy  Inhaled GCS (Beclomethasone, Budesonid, Fluticasone).  Seretid (GCS+Salmeterol) is used in patients with III- IV st. of COPD and oftern exacerbations in anamnesis.

31. Thanks for your attention!